TUG Flap, DUG Flap, and VUG Flap Reconstruction Procedures

There are three types of flaps that come from the same area of the upper inner thigh muscle, called the upper gracilis: 

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  TUG (transverse upper gracilis)

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  DUG (diagonal upper gracilis)

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  and VUG (vertical upper gracilis)

During a TUG, DUG, or VUG flap procedure, surgeons make an incision in the upper thigh near the groin, and take skin, fat, blood vessels, and part of the gracilis muscle to reconstruct the breast. Surgeons then attach the tiny blood vessels in the flap to the blood vessels in the chest using microsurgery.

These three flaps are named for the incision’s location on the upper inner thigh as well as the shape of the incision the surgeon uses:

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  a TUG flap requires an incision across the upper thigh

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  a DUG flap requires an incision that is angled diagonally down the thigh

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  a VUG flap requires an incision that runs vertically (up and down) on the thigh 

The gracilis muscle lets you bring your knees together and bend at your hips, but losing part of this muscle doesn’t significantly affect movement or function. After a TUG, DUG, or VUG flap procedure, your thigh feels tighter, though — as if you’d had a thigh lift. You also have a relatively long scar, but it’s generally well hidden since it’s on the upper inner thigh.

TUG, DUG, and VUG flap procedures take from three to four hours. 

The TUG, DUG, and VUG flap procedures may make sense for you if:

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  you don’t have enough tissue on your abdomen for a DIEP flap or other type of abdominal flap procedure

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  you have small- or medium-sized breasts and don’t want to increase your breast size with reconstruction

If you and your medical team decide that a TUG, DUG, or VUG flap procedure is right for you, you may want to ask your cancer care team to refer you to plastic surgeons who specialize in these types of thigh flap reconstructions, as they’re not as widely available as some other types of flap reconstruction. 

Surgeons make a recommendation for one of the three procedures based on:

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  how tight or loose the thigh skin is

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  which area of the thigh has enough tissue for the flap

Note that it’s still possible to have any of these three thigh flap procedures if you’ve had liposuction on your thighs.

For any of these three types of thigh flap procedures, you usually stay in the hospital for three days. Recovery can take about four weeks, although it might be a little longer if you have surgery on both thighs.

Your surgeon may recommend you wear a compression girdle with shorts that cover the upper thigh for up to eight weeks after surgery. 

Recovery from each of these thigh flap procedures may be a little more difficult because of where the incisions are located as well as the risk of healing issues. It can take as long as a year or more for your tissue to completely heal and for your scars to fade.

Follow your surgeon’s instructions after surgery and keep the area clean, dry, and protected.

It’s possible to walk after surgery, but it’s necessary to avoid movements that flex the hips or spread the legs.

Your thighs might look uneven after having any of these thigh flap procedures, especially if the surgeon uses only one side.

Health insurance might not cover procedures to correct unevenness in your thighs after surgery. Call your health insurance provider to check. You also may want to ask your surgeon if there’s a way to avoid unevenness or if another type of flap procedure makes more sense for you.

As with any surgical procedure, TUG, DUG, and VUG flap reconstruction surgery has some risk of necrosis and fat necrosis.